This study shows that indirect pulp therapy performed in primary and permanent teeth of young patients may result in a high 3-year survival rate. The unique physiochemical properties of MTA also promote a superior environment for pulpal repair and bridge formation, compared to CH products. Comparative studies have demonstrated MTA to be an appropriate replacement for formocresol for primary molar pulpotomy. 34-39. It is likely that recommendations going forward will require sealing the orifices as the main objective. From the introduction of indirect pulp capping by Pierre Fauchard in the eighteenth century, dentistry has recognized the innate reparability of the dental pulp when exposed to injury. Alternatively, adhesive resins have shown some promise when combined with additives or growth factors, such as hydroxyapatite powder, dental matrix protein-derived synthetic peptides, calcium chloride (CaCl 2 ), calcium phosphate, and antibacterial agents, including 12-methacryloyloxydodecylpyridinium bromide (MDPB). However, financial considerations or low dental IQ result in some patients refusing the optimal treatment. After MTA pulp capping, both sialoprotein and osteopontin have been observed in the fibrodentin matrix at the exposure site during the process of reparative hard tissue formation. 23-14 ). In a different randomized clinical study, Nair and colleagues investigated the pulpal response to direct pulp capping in healthy human teeth with MTA versus calcium hydroxide cement (Dycal) as control. It is subadjacent to the odontoblastic layer and is traversed by capillaries, unmyelinated nerve fibers, and cytoplasmic processes of fibroblasts. The radicular orifices are assessed to determine that bleeding can be controlled only by direct pressure with a damp cotton piece for a minute or 2. Subsequent advances have been complemented by newly developed dental materials that provide superior sealing properties and protect the pulp from microorganisms and their toxic by-products. 1. These procedures are performed routinely in primary and permanent teeth. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Pediatric Endodontics: Endodontic Treatment for the Primary and Young Permanent Dentition, Cleaning and Shaping the Root Canal System, Endodontic Records and Legal Responsibilities, Pulpal Reactions to Caries and Dental Procedures, Structure and Functions of the Dentin-Pulp Complex. 22. Vital Pulp Therapy Challenges and Promises in Permanent Teeth Fahda Algahtani* Clinical dentistry department, Princess Nourah Bint Abdulrahman University, Saudi Arabia Abstract The question about the exact indications and contraindications of vital pulp therapy in permanent teeth never settled down. The coronal pulp tissue can also be removed completely to the pulp floor or cervical area (pul­potomy) in the case of molars and some premolars. Vital pulp therapy for children is simple. Apply pressure with a moist sterile cotton pellet on the pulp stump to control hemorrhage. In this instance, the coronal and radicular pulps should be removed all the way to the apex of the tooth. Pulp proper: the central mass of the pulp, which consists of larger blood vessels and nerves. Vital pulp therapy is designed to preserve and maintain pulpal health in teeth that have been exposed to trauma, caries, restorative procedures, and anatomic anomalies. It is subadjacent to the predentin and is composed of cell bodies of the odontoblasts, capillaries, nerve fibers, and dendritic cells. J Endod 2012; 38: pp. Recently a new material has been introduced, BioAggregate (BA) (Innovative BioCeramix, Vancouver, British Columbia, Canada). When decay or tooth preparation extends into the coronal pulp, and the pulp is deemed vital (as described previously), a pulpotomy may be performed. One of the primary purposes of the human dental pulp is dentin formation.